Now we're going to talk about seizures in children. There's a lot of things that can
cause a seizure. I mean we could list them out, and it is so varied. It's incredible.
But the point of the matter is, what do we do with the patient who has a seizure, and
when do we know when to call 911? Very rarely, we'll have an epileptic child who has a standing
policy that they give to the educators where they're not supposed to call the ambulance,
because they're a known epileptic. There's a way of treating that. But in most cases,
and especially when you didn't know that the child was an epileptic or that there was a
standing policy, we're simply going to go ahead and just treat them as if this was their
very first seizure, no matter what the reason they had it. We're going to make sure that
the scene is safe, our CPR shield is available in case they're in full cardiac arrest, and
then we're going to go ahead and start treating the seizure patient. The first thing we want
to make sure of is that there's nothing surrounding an actively seizing patient that could cause
more harm, like sharp objects, chairs, pointed metal. In this case we're at a playground.
Maybe they're too close to the monkey bars. And there's different kinds of seizures. There's
the petit mal seizures, there's the grand mal seizures, there's the tonic and the clonic,
or just the tonic. Tonic-clonic means they're kind of contracting and then letting go, and
contracting and letting go. We saw a little bit of that where she was kind of bumping
her head on the ground, but it wasn't real exaggerated. It was just kind of more of a
moderate seizure. But if they're really tonic and then clonic and they're seizing hard,
they could be causing more secondary injuries simply because nothing's protecting them during
the seizure. In that case, if we had something soft that we could place under their head,
we would do that-- rolled up coat, hoodie, towel, diaper. If we don't have anything else,
our hands cupped underneath their head, just so that's something softer for them to comfort
their head so they don't have a concussion. After the seizure has passed, that's when
we go into our secondary assessment and make sure that we know what we're dealing with.
Check for any major injuries or bleeding. Make sure that if there's anything that's
kind of obstructing their airway we're aware of that. But more importantly than anything
else, that we get this person into a recovery position that they can then go through their
recovery time while the gravity works with them and not against them. In other words,
we want gravity to kind of pull their saliva, or maybe they bit their tongue, and so the
blood that they may be having in their mouth from the bitten tongue could then come out
and to the side. They might also get sick and vomit. That too could then flow out of
their mouth and not back into their airways. So as we're doing this, we've already checked
the patient over. We know that there's no real serious other injuries other than the
seizure that occured. We activated EMS or called 911, because to us, this was this child's
first seizure. We don't know anything else, and so we're going to call 911. And then as
they come out of the seizure, here's how we put them into the recovery position. This
position's going to allow for gravity to help keep fluids out of her airway and put her
in a position of comfort while she's recovering from the seizure while we await EMS's arrival.
So the first thing we're going to do here is we're going to bring the hand that's closest
to us and bring it up over her head. Remember, we don't suspect any spinal cord injuries
or anything like that, so we're not in any danger of moving limbs around, but here we're
going to raise this up here. Now we're going to take the leg that's furthest away and bring
it over and hook her ankles, so it keeps her whole body rolling as a unit. Now I'm going
to grab her wrist and her hip while I reach under the head and neck as I draw the patient
towards me. The rescuer always draws the patient towards themself so as to be able to control
the roll. If I were to try to push her away, there's a risk that it would be really uncoordinated
and that we risk rolling them all the way over onto their face, and we don't want that
to happen. I also like to keep my eye on the expression and the face to see if there's
any signs of pain or responsiveness, and so this is the method for rolling a patient.
Now I'm going to grab down here on the knee and I'm going to bring the knee up to be able
to be like a kickstand of sorts so she doesn't roll the rest of the way over. Now I grab
her head, support it while I untuck my hand, and lay her head down on her arm. I roll her
just a little bit more so that we have gravity now working with us, not against us, bring
any blood, saliva, or vomit out of her mouth, which is very common secondary to seizures.
Now some things to note here. We talked about blood in the mouth. That's usually because
they bite their tongue, very common. They could also break off teeth. Years ago there
was this understanding that we were trying to put these bite blocks in place to prevent
that from happening. Not anymore. We don't put anything in the seizing patient's mouth
at all. We don't try to put our fingers in there, we don't put any bite blocks, we don't
put any pens or combs or brushes, nothing. We just keep the person's mouth as safe as
we can and deal with it after the fact. Having them in this recovery position helps keep
their airway open, but if this person were to actually have any problems, we would roll
them back onto their back, and then we would actually begin our assessment and treat accordingly,
if they stopped breathing, lost their pulse, or anything like that. Remember, it's important
that if the patient is seizing, we're not trying to hold them down. We're not trying
to stop them from convulsing. We're just trying to keep them safe while they are in that convulsion.
Then after that passes and they're in the recovery phase, we then put them back in the
recovery position and await EMS's arrival.